La penna e il logoro: il Roman dels auzels cassadors di Daude de Pradas nel panorama della letteratura di falconeria. Studio introduttivo, saggio di traduzione e commento.

This work provides an overview of medieval falconry treatises, focusing on the Roman dels auzels cassadors by Daude de Pradas. The study examines the genre of the work, positioned between a didactic treatise and a courtly composition, while exploring its sources, content, and influence on subsequent literature. A central part of the research consists of the first complete Italian translation of the text. The process of translation served as a philological tool to test the reliability of the standard critical edition (Schutz, 1945), highlighting the limitations of a purely conservative approach and the necessity for a reassessment of the manuscript tradition. Through a comparison of the witnesses, emendations are proposed for previously obscure or corrupt passages, alongside a revision of the editorial punctuation. The study is accompanied by an apparatus of notes discussing the main linguistic and interpretative issues that have emerged within the critical debate

La mammografia con mezzo di contrasto: l’esperienza dell’UOSD di Livorno-Cecina-Piombino-Isola d’Elba

The aim of this study was to report the experience of the Livorno-Cecina-Piombino-Isola d’Elba Breast Unit with contrast-enhanced mammography (CEM) during its first two years of use, analyzing its clinical indications, causes of failed examinations, diagnostic performance in detecting malignant breast lesions, role in local preoperative staging, and assessment of response to neoadjuvant therapy. A retrospective study was conducted on 398 patients who underwent CEM between December 2023 and December 2025. Local staging of breast cancer was evaluated in a subgroup of 153 patients by comparing lesion index size measured with CEM and conventional imaging against surgical pathology. CEM showed sensitivity of 96%, specificity of 91%, accuracy of 93%, PPV of 92%, and NPV of 95%. The examination could not be performed in 3% of cases. In preoperative staging, CEM demonstrated good dimensional accuracy, with a mean overestimation of 2.7 mm versus an underestimation ≥10 mm by conventional imaging (p=0.017). It identified additional lesions in 30% of cases, leading to supplementary biopsies in 16%, with malignancy confirmed in 43%. It avoided biopsies for doubtful findings in 24% of cases and changed surgical planning in 12%, favoring more extensive surgery in 11% and more conservative treatment in 1.3%. In post-neoadjuvant assessment, CEM showed sensitivity of 56%, specificity of 88%, and accuracy of 71%, with accurate estimation of residual tumor burden. The study confirms the high diagnostic accuracy and clinical versatility of CEM across different breast imaging settings

Lesioni del muscolo elevatore dell'ano nel post-partum: studio ecografico transperineale

The female pelvic floor is a complex anatomical and functional system, whose structure is the result of evolutionary adaptations linked to the compromise between bipedalism, encephalization, and obstetric needs. Within this structure, the levator ani muscle (LAM) plays a fundamental role in supporting the pelvic viscera, controlling urinary and fecal continence, and supporting sexual function. Vaginal delivery is the most traumatic event for the pelvic floor during a woman's entire life, subjecting the LAM to levels of stretching that, during the second stage of labor and especially during the crowning phase of the fetal head, can far exceed the thresholds considered physiologically tolerable for striated muscle. Biomechanical models based on magnetic resonance imaging have shown that the medial pubococcygeal bundle can reach a stretch ratio of more than three times its resting length, exceeding the estimated ‘non-injurious’ threshold for skeletal muscles by more than 200%. In this context, pelvic floor trauma should not be considered a rare or exceptional event, but rather a possible consequence of vaginal delivery, the severity of which is influenced by a combination of obstetric factors, maternal characteristics, and duration of exposure to mechanical stress. LAM trauma is traditionally divided into macrotrauma and microtrauma. Macrotrauma is generally described as a partial or total avulsion of the LAM from its pubic insertion site, while microtrauma is characterized by irreversible overstretching of the hiatus area, known as “ballooning.” These two conditions are not mutually exclusive, as they can coexist and represent different expressions of the same injury process, with partially different determinants and functional implications. The clinical diagnosis of LAM trauma in the postpartum period presents numerous difficulties. Physical examination and simple inspection of the birth canal show low sensitivity in identifying LAM lesions, which often remain clinically occult. In this scenario, 3D/4D transperineal ultrasound has established itself as the diagnostic method of choice, thanks to its non-invasive nature, the possibility of performing dynamic assessments (at rest, during contraction, and during the Valsalva maneuver), and the high reproducibility of the measured parameters. The use of Tomographic Ultrasound Imaging (TUI) allows for a systematic, multi-layered analysis of LAM integrity, reducing the risk of underestimating partial avulsions, while measuring the hiatus area at maximum Valsalva allows for objective documentation of the presence of microtrauma. The main objective of the study was to determine the prevalence of postpartum LAM trauma in a population of primiparous women, using 3D/4D transperineal ultrasound and distinguishing between macrotrauma and microtrauma. Secondary objectives included analyzing the association between LAM trauma and pelvic symptoms (urinary, anorectal, and sexual) and identifying the main obstetric and maternal risk factors associated with different types of injury. A prospective longitudinal observational study was conducted at the University Hospital of Pisa, involving primiparous women aged ≥ 18 years who had undergone vaginal delivery and were evaluated between 3 and 10 months after delivery. All participants underwent a urogynecological evaluation, 3D/4D transperineal ultrasound examination, and completed validated questionnaires (ICIQ-FLUTS, FSFI, and Wexner score). Macrotrauma was defined as partial or total avulsion of the LAM detected by TUI, while microtrauma was defined as hiatal ballooning with a genital hiatus area > 25 cm² at the peak of the Valsalva maneuver. Of the 213 women contacted, 68 completed the entire study protocol. The average age at delivery was approximately 34 years, and the assessment was performed on average 7.5 months after delivery. Macrotrauma of the LAM was found in 17.6% of women, exclusively in the form of partial avulsions, predominantly unilateral. Microtrauma emerged as the most common condition, being present in 38.2% of the study population. All women with macrotrauma also had microtrauma, supporting the hypothesis of a continuum of LAM damage. Overall, approximately 62% of participants had no ultrasound signs attributable to LAM trauma. Univariate analysis revealed a significant association between both types of trauma and operative delivery, the use of the Kristeller maneuver, episiotomy, and the duration of the expulsive stage. Neonatal parameters (weight and head circumference) were mainly correlated with microtrauma, while maternal age showed a significant correlation with macrotrauma. In addition, third- and fourth-degree perineal lacerations (OASIS) were significantly associated with LAM trauma, particularly macrotrauma. From a clinical point of view, both microtrauma and macrotrauma were associated with a higher prevalence of urinary and anorectal disorders. In particular, women with LAM trauma had higher ICIQ-FLUTS and Wexner scores than women without injuries. Conversely, sexual function impairment, as assessed by the FSFI, was significantly higher only in women with macrotrauma, suggesting a gradient of functional impairment proportional to the severity of structural damage. Multivariate analysis, performed using separate logistic regression models for macrotrauma and microtrauma, identified independent predictive factors for each condition. For macrotrauma, the duration of the expulsive stage and maternal age at delivery were found to be independent determinants, while the mode of delivery did not maintain an independent association after adjustment. For microtrauma, however, the duration of the expulsion period and the mode of delivery were confirmed as independent predictors, with spontaneous delivery associated with a significantly lower risk than operative delivery. Overall, these results suggest that macrotrauma represents the expression of more severe structural damage, strongly influenced by the reduced tissue adaptability associated with maternal age, while microtrauma appears to be mainly related to the intensity and duration of mechanical stress exerted on the pelvic floor during the second stage of labor. Overall, the results confirm that postpartum levator ani muscle trauma is a frequent occurrence, often not clinically evident, with microtrauma being the most common manifestation, still poorly studied and likely underestimated in the literature. Transperineal 3D/4D ultrasound is confirmed as a fundamental method for the objective identification of different forms of LAM trauma and for the stratification of functional risk in the postpartum period. The integration of this approach into postpartum follow-up could allow for earlier identification of women at higher risk of pelvic dysfunction, facilitating the adoption of preventive interventions and more targeted clinical management strategies in the medium and long term

Gestione e trattamento dei pazienti con fibrillazione atriale con accesso presso l'Azienda Ospedaliera Universitaria Pisana

Atrial fibrillation (AF) represents the most frequent cardiac arrhythmia in clinical practice and is today considered one of the main health challenges in the cardiovascular field. Its relevance derives not only from the high prevalence in the general population, but above all from the association with a significant increase in morbidity and mortality, in particular due to the risk of ischemic stroke, heart failure, recurrent hospitalizations, and functional decline, with a relevant impact on patients’ quality of life and on healthcare costs. From a historical point of view, irregularity of the pulse was one of the first clinical alterations described in medicine; however, only with the introduction of electrocardiography at the beginning of the twentieth century was it possible to define atrial fibrillation in a systematic way as an autonomous entity. Since then, AF has become the object of growing clinical and scientific interest, parallel to the evolution of pathophysiological knowledge and to the development of increasingly sophisticated diagnostic and therapeutic strategies. As regards pathophysiology, AF is characterized by disorganized atrial electrical activity that determines the loss of effective atrial contraction, with consequent compromise of hemodynamic efficiency and increase in thromboembolic risk. Cardioembolic stroke represents the most feared complication and is responsible for a relevant proportion of permanent disability and mortality. At the electrocardiographic level, AF manifests itself with the absence of P waves and the presence of fibrillatory waves of variable amplitude and morphology (f waves), associated with an irregular ventricular response, which is expressed with irregularity of the R–R intervals. In recent decades, the understanding of atrial fibrillation has profoundly evolved. It is no longer considered a static condition, but a dynamic and progressive pathology, which tends to evolve over time from paroxysmal forms to persistent and permanent forms. This continuum is supported by processes of electrical and structural remodeling of the atria, which contribute to the progressive stabilization of the arrhythmia and to the reduction of the effectiveness of therapeutic strategies. In light of such considerations, atrial fibrillation represents a topic of primary importance in modern medicine. Early identification, stratification of thromboembolic and hemorrhagic risk, and the definition of appropriate therapeutic strategies, including control of rate or rhythm and correct anticoagulant therapy, constitute fundamental elements for improving prognosis and patients’ quality of life. The growing interest toward integrated and personalized approaches reflects the complexity of this arrhythmia and the necessity of rigorous and evidence-based clinical management